Archive for January, 2011

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Back to (a New Kind of) School at FIU

January 28, 2011

By Maureen ‘Shawn’ Kennedy, AJN editor-in-chief

Florida International University (FIU) is only a short drive from downtown Miami. Since I was going to be in town for two conferences (see my previous post on the CNL conference), I thought I would schedule a visit with Divina Grossman, an AJN editorial board member who is the vice president for engagement at FIU (that is, she’s responsible for developing and expanding community partnerships). Unfortunately, Dr. Grossman, formerly the dean of the College of Nursing and Health Sciences (CNHS), was out of town, but I accepted an invitation to visit the school and meet with the interim dean and faculty members.  Read the rest of this entry ?

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True Believers at the 2011 Clinical Nurse Leader Summit

January 26, 2011

By Maureen ‘Shawn’ Kennedy, AJN’s editor-in-chief, who is in Florida this week attending meetings and visiting local schools

It’s January and I’m in Miami (I know, I know). I just finished attending the CNL 2011 Summit (CNL = clinical nurse leader). It was a relatively small meeting, as nursing meetings go, with about 350 attendees who were CNLs, faculty or students in CNL programs, or chief nursing officers from clinical facilities employing CNLs. They were all believers in the value the role brings to clinical practice. There was an energy, an atmosphere of being in on a new and growing phenomenon.

Some background: the CNL is a relatively new role in nursing, first formally proposed by the American Association of Colleges of Nursing in 2003 after several meetings with other nursing groups concerned with nurses’ “education for practice” (see the white paper on the development of the role). CNLs function at the unit level, coordinating care, working with staff, focusing on improving outcomes.

Described as “master’s-prepared advanced generalists,” CNLs now number about 1,300, according to Mary Stachowiak (see photo), president of the Clinical Nurse Leader Association (CNLA). There are currently about 100 institutions with master’s programs preparing CNLs and about 1,800 CNLs in programs.

AJN carried a short news article back in October 2004 noting the creation of the new role, and in December 2005 we reported on the controversy surrounding the role,  much of it coming from the National Association of Clinical Nurse Specialists (NACNS), who saw the role as duplicating some aspects of the CNS role in a way that might “disenfranchise” those who already had that credential.

More recently, our update in January 2010 showed that, while there still were some reservations about the role, broader support was emerging. Read the rest of this entry ?

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Neither Dragons nor Angels — Just Imperfect, Like Everybody Else

January 21, 2011

By Gail Pfeifer, MA, RN, AJN news director

I’m not a history buff, but my husband is. So I nicely went along on a recent trip with him to Virginia, visiting historic sites like Montpelier, Jamestown, Yorktown, and Appomattox. It was more fun than I’d anticipated and it really did open a door for me, showing me how much, and how little, has changed, especially in political behavior: When Cornwallis had to surrender to Washington, for example, he feigned illness and sent his second in command, General O’Hara, to do so. Washington, in return, would not accept the sword from O’Hara, directing him to his own second in command. Tit for tat.

Interior doorways, Clover Hill Tavern, Appomattox Court House

One of the things I least expected from the National Park Service was a specific acknowledgment of nurses or nursing (except for maybe Clara Barton, who established the American branch of the International Red Cross). Yet there it was at one of our Civil War site stops: a note that Dorothea Dix had visited to review care of the Union soldiers.

Although she is best known for her work improving care for the mentally ill, Dix became Superintendent of Female Nurses for the Union during the Civil War, serving for the entire duration without pay. At that time, biographers say (variably) that she was 59 or 60 years old, a strong, unmarried woman of her times. Dix was a social reformer and far from politically correct for her day. They called her “Dragon Dix” because of her outspoken opinions and her “autocratic” approach to choosing nurses who could serve under her aegis—no hoop skirts, no jewelry, and preferably plain looking and over 30. Despite her nickname, and perhaps (depending on how you view appropriate behavior in women) her flaws, you can find her described online, along with Barton, as an “Angel of the Battlefield.”

These polar-opposite labels tweaked my interest in nursing history and made me wonder: How far have we come as nurses in the eyes of those we serve, and how do these labels end up persisting over decades? Are we either dragons or angels, or will we finally be acknowledged as professionals with individual, imperfect personalities who work to improve health care? When new nurses look at nursing history 150 years from now, what doors will they see opened, by us, in 2011?

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Nurses, Hospitals, and Social Media: It Depends What Business You’re In

January 19, 2011

By Julianna Paradisi, RN

Zuckerberg/via Flickr, World Economic Forum

Before the placenta picture posted on Facebook by a nursing student made national news, I read Time Magazine’s “Person of the Year 2010,” by Lev Grossman. Born in 1984, Mark Zuckerberg, the inventor of Facebook, is decades younger than the average working nurse. According to the article, so many people now belong to Facebook that if the Web site were a country “it would be the third largest, behind only China and India.” To refuse to recognize the social impact of Facebook is to miss the boat.

Throughout the nurse blogosphere, nurses are demanding that hospitals create policies about the use of social media. Some hospitals have. Not surprisingly, these documents state that no unauthorized photographs of staff, patients, or patient care areas should be taken, let alone posted on the Internet.

Hospitals with social media policies are not necessarily squelching their employees’ right to freedom of speech. They don’t want to spend time and money in court defending their public image. They already spend lots of money on marketing. They are in the business of patient care, not entertainment. So hospitals with social media polices take the position that you can post or tweet to your heart’s content, but should keep in mind the following:

  • Nothing you post is private.
  • If your online behavior disrupts patient care or creates hospital liability, the hospital reserves the right to fire you.

Consider your personal commitment to your own rights. Do you really want to catch every ball that’s thrown to you? Hospitals don’t want to spend their time and money on social media lawsuits. Do you?

Social media is not going away. One of Mark Zuckerberg’s profitable insights is that people like reading about and seeing their friends and friends of friends online. A few years ago, many of us were upset when the Patriot Act made it possible to force libraries and bookstores to report which books their patrons read. Now we want everyone to know what books we “like,” and no one seems to mind that Amazon tracks what we read, then focuses ads according to our purchases.

My own concept of privacy is changing. Read the rest of this entry ?

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HCR: Been There, Done That

January 18, 2011

By Maureen ‘Shawn’ Kennedy, AJN editor in chief

I was doing some research in the AJN archives and came across an editorial written in November 1993 by Virginia Trotter Betts, then-president of the American Nurses Association. “The Best Buy in Health Care” (click through to the PDF option; article will be free until July 18) reads like it was written with the Institute of Medicine’s Future of Nursing report in mind. Here’s an excerpt for those who don’t have access to the AJN archives (a shameless plug: subscribers have full access to ALL the issues of AJN, back to the very first issue in 1900—a treasure trove of nursing history):

“But we must also face the fact that such reform will require significant changes in nursing. Nurses will have to operate with greater autonomy and deliver care to a broader clientele. To foster enhanced roles for nurses as case managers and team leaders, nursing administrators must alert the work environment to offer a continuum of care on site and off site. Nurse educators will need to offer innovative programs, curricula, and clinical placements that prepare nurses for careers characterized by critical thinking and maximum flexibility. Nurse researchers will need to add more health care system, economic and policy studies to their repertoire.”

And another:

“Nurses want to do more in a reformed system to facilitate access at a reasonable cost.  We want to do what we are educated to do – provide basic health services like well and ill baby care, immunizations, and health screenings; manage chronic conditions; care for the sick and dying using both technology and interpersonal techniques; and a multitude of other essential services that are well within our expertise.  We want to educate our client and our communities and form a health care partnership with them.  We are team players and are ready to try to make new systems work for consumers.”

If only nurses ruled the world . . .

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The Real Criminals Here: Justice is Served in Winkler County, Texas, Whistleblower Case

January 17, 2011
Map of USA with Texas highlighted

Image via Wikipedia

By Maureen ‘Shawn’ Kennedy, AJN editor in chief

On January 13, news from Texas let nurses everywhere take heart that, sometimes, the system works. According to a report by the Odessa American, the Winkler County, Texas, officials, Sheriff Robert Roberts and attorney Scott Tidwell, who had filed charges against whistleblower nurses Anne Mitchell and Vicki Galle, have been indicted on felony charges of misuse of official information. The hospital administrator who fired the two nurses, Stan Wiley, was also indicted. For more on the story, which we’ve kept a close eye on since October 2009 in our news reports and on this blog, see this ABC World News article; the Texas Nurses Association also has an archive of the case.

In a separate civil suit against the county, Mitchell and Galle were awarded $750,000. Very excellent.

Why is this so exciting and significant? The case outcome supports nurses who raise concerns about unsafe patient care and upholds the nurse’s right—duty, really—to advocate for patients. Hopefully, the nurses’ victory and the award from the civil suit will give pause to those who think they can intimidate nurses who are acting on good conscience and within legal and ethical boundaries.

Kudos to the courts for realizing who the real criminals are.

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Placenta Facebook Photos: Nurse and Mommy Tribes See Student Expulsion Differently

January 12, 2011

By Shawn Kennedy, AJN editor in chief

Many of you may be familiar with the recent “nursing-in-the-news” topic involving nursing students and a placenta. (For those who’ve been out of touch, here it is in a nutshell: three students were involved in photographing themselves with a placenta from a recently delivered mother and posting it on, where else, Facebook. The students were expelled. One student sued; the judge ordered all the students reinstated. See this article by the Kansas City Star that sums it up.)

The incident has provoked debate on various Web sites, including our own Facebook page, where the discussion mainly concerns whether the students were treated fairly or too harshly:

“It’s a placenta. I agree that it can seem a bit juvenile to photograph yourself with it, but an offense worthy of expulsion?”

“Juvenile? Perhaps. Punishable by expulsion? Absolutely not, imo. What exactly was wrong with taking a picture of a placenta? It’s not like you can identify who the placenta came from.”

“I think she should be punished but not expelled. in all reality a placenta is medical waste after delivery but it showed no respect for her patient, which needs to be addressed.”

And a really interesting question:

“Would she have been handed the same punishment had it been a picture of a full bed pan?”

Other sites also argue the “no harm, no foul” rationale—since there was no way to link the organ to a patient and so no breach of privacy, what was the harm? Comments on one of several posts about this issue at Those Emergency Blues came out in favor of the students. Nurse and blogger Phil Baumann’s post, “The Placenta Incident and The Shawshank Redemption,” did as well.

The school did seem to react harshly, especially when there seems to be some question as to whether the clinical faculty member might have been aware of the students’ activities.

However, there was a decidedly different tone on a blog called The Stir at CafeMom, a Web site focusing on pregnancy and motherhood, that should give us pause. Author Jean Sager writes the following in a post called “New Pregnancy Fear: Who’s Got Your Placenta Now?”: Read the rest of this entry ?

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Hour of Lead

January 10, 2011
originally uploaded on en.wikipedia by Wragg a...

Image via Wikipedia

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s written several previous posts for this blog (here’s the most recent).

Last week two of my patients died. This alone is not unusual in the ICU. What makes it feel different  is that I’d cared for each of them enough times to develop a solid sense of them and had come to know their families well. They died on consecutive shifts and their contrasting situations, coupled with their proximity in time, have left me unsettled. Poems of Emily Dickinson skitter through my head . . .

I reason, Earth is short-
And Anguish-absolute-
And many hurt,
But, what of that?

The first was a girl who’d fallen and hit her head. She’d been healthy, young, and strong, but it was a devastating blow. Her parents were dazed with shock. As a nurse I was up to the medical tasks, but the “mother” side of me was overwhelmed by their tragedy. When she died I slipped out and left them with the chaplain, lest I crumple into a puddle on the floor.

I reason, we could die-
The best Vitality
Cannot excel Decay,
But, what of that?

My other patient had fallen, as well, but he’d lived a full life and reached an advanced age. As pale and fragile as a baby bird, he lay in quiet dignity and peace. His family gathered around him and held his hands, each of his breaths drawing longer apart and shallower until he slipped away as gently as a morning star fades with the breaking day.

When the elderly man passed there was a prevailing sense that all was as it should be. That “rightness” did nothing to assuage the feeling that the young girl’s death had been unjust. If anything, the contrast made her death seem crueler. Ironic (and unfair), that the one who should have been the strongest was the most delicate, in the end.

I’ve been home from work for days—and plagued with this. At home I have more time to dwell on life and death, and on what seems fair. But instead of searching for resolutions that clearly aren’t mine to find, I’ll write to clear my head, then leave the ruminations to the poets.

I reason, that in Heaven-
Somehow, it will be even-
Some new Equation, given-
But, what of that?

(Indented excerpts are from Emily Dickinson, poem #301)

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An NP Prepares: Calling All Nurse Mentors

January 7, 2011

Jen Busse, RN, MPH, is an intern at the Center for Health, Media and Policy at Hunter College in New York City and is currently pursuing her MSN as a family nurse practitioner at Columbia University. This is her second post about studying to be an NP. Her first was “An NP Prepares: When Normal is Better Than Fine.”

While we watch schools of nursing significantly increasing class sizes in a stalled economy, students are still being told that new nurses should “have no trouble” securing jobs upon graduating. Advancing our careers won’t be an issue either, we’re told.

We new nurses, in masses, are then sent out to fend for ourselves. Many schools of nursing lack career services help for students—possibly due to the myth of the “nursing shortage.”

Well, I’m here to tell you, from the evidence gathered in my own laborious, and mostly fruitless, job search, that archaic ideas about the ease of finding a position as a nurse are dead wrong. What we really want to do is to take care of patients, not spend years of our lives searching for an opportunity to do so. 

So in steps the nurse mentor—if you’re lucky.

Unfortunately, career mentorship for many new and experienced nurses is rare, creating difficulties in securing a job or advancing one’s career. Without role models, it’s difficult to feel motivated or to gain confidence in your abilities. A seasoned professional or trusted peer is crucial in providing helpful advice, guidance, and inspiration. Nurse mentors offer protégés their knowledge and wisdom, in the process creating a legacy for future generations through the creation of new nurse leaders.

I was incredibly fortunate to find two women, both important nurse leaders, Barbara Glickstein and Diana Mason (bios here). They helped to pull me out of my despair of joblessness, when I had all but abandoned my hopes of working in nursing, and have helped to guide me to what I now see as a promising future in this field. They’ve helped me build my confidence, especially through writing about health-related issues, and shown me that I do have something special to offer to the field of nursing. Read the rest of this entry ?

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Choosing AJN’s Med-Surg Nursing Books of the Year

January 6, 2011


By Julie Zerwic, PhD, RN, interim executive associate dean, College of Nursing, University of Illinois at Chicago

The faculty in the department of biobehavioral health science at the University of Illinois College of Nursing looked forward with enthusiasm this fall to our opportunity to pick the AJN medical—surgical book of the year. The range of books that are submitted is outstanding and it was a challenge to find the book that we felt was deserving of the title. In fact, we selected two books. Both selections fill a need, covering material neglected in other works. 

How to Manage Pain in the Elderly, by Yvonne D’Arcy, will be useful for any nurse working with older adults in pain. The book begins by dispelling myths about the experience and treatment of pain in the elderly. The material in each chapter is brought together by text boxes, figures, and rich case studies. The book includes material on the physiology of pain in the elderly, pharmacologic and nonpharmacologic approaches to pain management, issues of multidrug therapy, and palliative care.

I recently watched as my 75-year-old mother experienced a long episode of pain after knee replacement surgery. An infection and then problems with a degenerative spine left her searching for some type of therapy that would relieve the debilitating pain. Many of the concepts that D’Arcy covers in her book were relevent to the situation my mother found herself in. This book will provide a resource as health care providers learn to more effectively manage pain in the elderly.

Acute Stroke Nursing was edited by Jane Williams, Lin Perry, and Carolyn Watkins. Few resources have been available for nurses who work with patients who experience the devastating consequences of stroke. This is a comprehensive resource that covers the complex anatomy of the brain and the pathophysiology of stroke. The chapters cover the many and varied consequences of stroke, including incontinence, nutritional impairments, and physical impairments. Crucially, this book also addresses the changes that can occur to a patient’s mood.

The authors include international resources that may be useful to health care providers as well as to the patient and families. They also remind us that the impact of stroke can be felt by the patient and family long after the initial event; this comprehensive long-term focus is evident throughout the book. Chapters are devoted to assisting the family as well as to palliative care. Key points and case studies also contribute to this book’s usefulness.

(Editor’s note: to see all the books, from a wide variety of categories, selected for the AJN 2010 Book of the Year Awards, click here.)

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